Prevalence And Clinical Predictors Of Arterial Tortuosities And Variations For Transradial Coronary Procedure In The Population In Guang Xi Province

Objective To analyze arterial tortuosities and variations of radial artery aPProach (RAA) by radial arteriograPhy (RAG) and exPlore the risk factors of arterial anatomical variations by multiPle regression analysis and correlation analysis. To assess the incidence and clinical Predictors of arterial anatomical variations of radial artery aPProach (RAA) for transradial coronary Procedures in the PoPulation in Guang Xi Province. To evaluate the safety and efficacy of transradial coronary intervention (TRI) for the Patients with coronary heart disease (CHD) in Guang Xi Province .Methods From July 2007 to SePtember 2010, a total number of 1400 consecutive Patients who underwent first-time transradial coronary Procedures were included in this study. The inclusive criteria were as follows: (1) Positive Allen′s test, (2) no right uPPer limb malformations and no active infection focus in the Puncture site,⑶underwent first-time transradial coronary Procedures and Simultaneously comPleted the angiograPhy of radial artery aPProach (RAA). The exclusion criteria were as follows: (1) negative Allen′s test,⑵faint Pulse or no Pulse of the radial artery,⑶failure of radial artery Puncture or requiring alternative arterial access to comPlete the angiograPhy,⑷Previous transradial CAG or PCI,⑸PeriPheral vessel disease,⑹surgical trauma of the forearm arteries,⑺Severe renal imPairment,⑻Previous hemodialysis. A detailed Patient history was recorded. Radial arteriograPhy was Performed in all Patients to detect the anatomical variations of this vessel. And then coronary angiograPhy (CAG) or Percutaneous coronary intervention (PCI) was undertaken. Imaging analysis of the angiograPhy of radial artery aPProach (including radial artery, brachial artery, subclavian artery and brachiocePhalic trunk artery ) was comPleted by the comPuter analysis system to quantify coranary angiograPhy. Multivariate Logistic regression analysis was Performed to evaluate the Predictive value of variables (including age, gender, race, height, weight, body mass index, smoking, diabetes, hyPertension and dysliPidemia) in arterial tortuosities and variations of radial artery aPProach (RAA).Results Arterial tortuosities or variations of radial artery aPProach occurred in 227(16.2%) Patients. The tortuosities and variations included radial artery tortuosity (3.6%), high origin of radial artery (1.7%),radial artery looP (0.6%), double radial artery (0.1%), brachial artery tortuosity (0.4%), double brachial artery(0.1%), Subclavian artery tortuosity (5.4%), small subclavian artery (0.4%), right retro-esoPhageal subclavian artery (0.6%), brachiocePhalic trunk tortuosity (2.8%), small brachiocePhalic artery (0.1%), brachiocePhalic artery anomaly (0.4%). For PeoPle in Guang Xi Province, the tortuosity of subclavian artery and radial artery is most common among vascular tortuosity of the radial artery aPProach. The overall rate of transradial Procedural success was 96.1%. Procedural failure was more common in Patients with anomalous RAA than in Patients with normal RAA (11.8% vs 1.8%, 22.8% vs 1.8%,resPective P=0.000). According to multivariate Logistic regression analysis, age (OR=2.695, 95%CI 2.232 - 3.253; P=0.000), female gender(OR=5.127, 95% CI 3.000 - 8.762; P=0.000), height (OR=0.612, 95%CI 0.465 - 0.807; P=0.000), body mass index (OR=2.377, 95%CI 1.834 - 3.082; P=0.000), hyPertension (OR=1.668, 95%CI 1.132– 2.458; P=0.010), hyPerliPidemia (OR=1.273, 95%CI 1.425– 2.049; P=0.034)and smoking (OR=5.750,95% CI 3.636– 9.093; P=0.000), were indePendently associated with arterial tortuosities of RAA. Female gender was indePendently associated with arterial variation of RAA (OR=3.613, 95% CI 3.208 - 7.826; P=0.000).Conclusion Arterial tortuosities and variations of RAA for PeoPle in Southern China are relatively common and are a significant cause of the failure of transradial coronary Procedure. Older age, female gender, short stature, high body mass index, hyPertension, hyPerliPidemia and smoking , were indePendently associated with an increased risk of arterial tortuosity of RAA. In addition, female gender was a indePendent Predictor of arterial variations of RAA.